- iwatchnews.org/health/medicare/manipulating-medicare
- iwatchnews.org/2011/10/07/6898/forty-percent-medicare-spending-common-cancer-screenings-unnecessary-probe-suggests
- iwatchnews.org/2011/01/30/2166/unproven-older-women-digital-mammography-saps-medicare-dollars
- iwatchnews.org/2010/11/07/2333/little-known-ama-group-has-outsized-influence-medicare-payments
Provide names of other journalists involved.
Joe Eaton, Elizabeth Lucas, Rochelle Sharpe, David Donald
List date(s) this work was published or aired.
10-7-2011, 1-30-2011, 11-7-2010 , 4-19-2011, 8-8-2011, 4-8-2011, 4-21-2011
Provide a brief synopsis of the story or stories, including any significant findings.
Story 1 – Forty percent of Medicare spending on common cancer screenings unnecessary, probe suggests This story analyzed a six-year sample of Medicare billing records and found that the program spent about $1.9 billion on unnecessary cancer screenings during that period, which was 40% of the government agency’s total spending on breast, colon, prostate and cervical cancer screenings during that period. iWatch News analyzed a sample of Medicare billing records from 2003 to 2008, examining how many healthy people received cancer screening tests despite being older than government-recommended upper age limits for such tests. The investigation found that doctors were routinely ignoring screening guidelines developed by the U.S. Preventive Services Task Force, a panel of independent medical experts whose recommendations are considered the gold standard for medical care. More than $31 million of that money was spent screening people who were in their 90s, the investigation showed. In 2008 alone, at least a few dozen women 98 or older were getting mammograms.
Story 2 – Unproven for older women, digital mammography saps Medicare dollars This story documents how General Electric and other manufacturers of digital mammography technology used political influence and campaign donations to influence Congress to increase Medicare reimbursement for the new scans, despite scientific evidence that showed digital mammography is no better than traditional film mammography at detecting breast cancer in the majority of women, and may actually be worse. Between 2003 and 2008, the number of women who received mammograms fell slightly, however the cost to Medicare increased by more than $625 million. That extra spending, experts say, was an unnecessary payout to the medical industry and likely did little to save women’s lives.
Story 3 – Little-known AMA group has outsized influence on Medicare payments This story shows how a small and secretive group of doctors within the American Medical Association plays a key role in setting the prices that Medicare pays for procedures. Known as the American Medical Association/Specialty Society Relative Value Scale Update Committee, or RUC, the group of 29 medical specialists has for two decades served as the official arbiters of the value of medical procedures, and how much doctors will be paid for providing them. Because RUC membership is overwhelmingly comprised of medical sub-specialists, the group has a vested interest to increase Medicare payments for specialty care while decreasing payments for family doctors. The result has been the skyrocketing cost of specialty care, and the catastrophic decline of family practices, as medical students target more profitable specialties like radiology and cardiology. Our reporting showed how Medicare’s administrator has handed over its role in setting prices to a group of physicians with a clear conflict of interest, and how that has resulted in worse care and higher prices for the American public.
Stories 4-7 – The other four stories in this series document the impact of the above stories, including four bills before Congress inspired by our work.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
The reporting in the series used six years of Medicare physician billing data, which we received through an agreement brokered after the Center sued the Centers for Medicare & Medicaid Services after first attempting to gain access to the data through a FOIA request. The drawn-out process set our reporting back months, but the attention the battle garnered also help us win respect and attention from sources in the medical industry.
Explain types of human sources used.
In addition to the data, we also interviewed dozens of physicians, medical experts and patients. For the political connection, we searched Senate lobby records and talked to sources in Congress and with industry, which gave us a good footing to tell the story of how the medical industry influences Congress and Medicare administrators in order to profit from the system, often at the expense of patients.
Results:
Perhaps the best measure of impact from the Center’s Manipulating Medicare series is the current campaign for reform on Capitol Hill. Spurred by our reporting, three senators have introduced three separate bills that would make public the Medicare billing data the Center used in our investigation. Speaking during a Senate hearing, Sen. Ron Wyden, D-Ore, cited the Center’s investigation as the inspiration to the bill he introduced with Charles Grassley, R-Iowa, which would require the U.S. Department of Health and Human Services to create a free searchable Medicare payment database the public can use to track billing by health care providers. Sen. Dick Durbin, D-Ill, also cited the Center’s work when he introduced a similar bill in 2011 to make Medicare billing data public. The bills are opposed by the American Medical Association. In addition, our reporting on the American Medical Association RUC inspired Rep. Jim McDermott, D-Wash., to introduce a bill that would reduce the AMA’s influence on Medicare payment rates. Speaking on the floor of House, McDermott, a psychiatrist himself, slammed the RUC, calling it the “least known committee in the medical industrial complex,” and questioning why a group of doctors should be “setting their own fees.” We have also received praise from dozens of medical experts, doctors, and patients. We believe this project helped shed light, in a quantifiable manner, on systemic failures in the way Medicare’s administrators develop procedure payment policy. We believe our work and collaboration with other outlets has led to much greater public awareness of the problem and has started the process of significant reform.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No corrections or clarifications. No questions of accuracy.
Advice to other journalists planning a similar story or project.
Before you start your analysis, talk to experts familiar with Medicare data to make sure your methodology is valid. To find political connections that guided Medicare policy decisions, scan the Senate lobby disclosure database, which gives a deep historical look at the issues important to industry. Former representatives were also helpful to this series, since policy decisions often have long histories.